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Name:
Surname:
E-mail:
Telephone:
Skype ID:
Date of birth:
Citizenship:
Religion:
Mother's occupation:
Father's occupation:
Age of siblings:
City Town Village Countryside
Are you: Single Married Divorced
Qualification:
A-level (High school/ Secondary school) Bachelor degree Master (University) degree Other
Field of studies:
Level of English:
elementary pre-intermediate intermediate upper-intermediate advanced
Present / Previous job:
How long did you study English? (years)
Other languages?
Driver's license: Yes No
When did you receive your driver's license: (date)
How often do you drive?
daily weekly monthly occasionally
Type of roads:
city town village highways
Have you ever had a car accident? Yes No
If yes, please write details:
Are you happy to drive abroad? Yes No Maybe
Sports Arts Animals/Pets Swimming Travelling Music Cinema
History Photography Reading Computers Cooking Baking Other
Can you swim? Yes No
Are you in good health? Yes No
Do you have allergies? Yes No
If yes, please give details:
Do you smoke? Yes No Social (occasional) smoker Not in the house
Have you ever been convicted of any criminal offence? Yes No
Which month can you start?
Earliest possible start date:
Preferred lenght of stay:
Can you stay longer if happy in your host family?
Preferred position:
Au Pair Au Pair plus Mini Mother's Help Mother's Help
Preferred location:
capital city town village don't mind
Preferred age of children:
0-2 2-4 5-10 10+
Do you wish to attend language classes? Yes No Maybe
Are you willing to take care of pets? Yes No Maybe
Which age group do you have experience with?
(Please detail as much as possible, give us the type of experience, for example “childcare within family, childcare of friends' children, summer camps, nursery school, private teaching, babysitting, training children, work in school, hospital etc“ and fill in further questions)
Experience 1
Number of children, Age and Gender:
Activities/Duties:
Dates:
How often:
Experience 2
Experience 3
Experience 4
Reference 1
Tel.:
Speaking English? Yes No
Reference 2
Reference 3
Motivation letter: (Please detail as much as possible your motivation to be an au pair, write something more about you, your family, and your plans for future. You can also email the Letter to your agency.) Please see the example of motivation letter
I have read and understood this Application form. All the information given is true and complete. Přečetl/a a porozuměl/a jsem tomuto formuláři. Všechny uvedené informace jsou pravdivé a kompletní. Jsem si vědom/a, ze zodpovídám za poskytnutí nepravdivých nebo nekompletních informaci a za následky z toho plynoucí.
Office: Praha Brno Bratislava Košice Londýn
Antispam: Please fill in number 724.
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